Ala Mo'ui - Ministry of Health

Pathways to Pacific Health and Wellbeing2010–2014'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014a

Photos of nurses on front cover (bottom row, left and centre)are courtesy of Anthony Phelps.Citation: Minister of Health and Minister of Pacific Island Affairs. 2010.'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014.Wellington: Ministry of Health.Published in January 2010 by the Ministry of HealthPO Box 5013, Wellington 6145, New ZealandISBN: 978-0-478-33956-7 (print)ISBN: 978-0-478-33959-8 (online)HP 4975This document is available on the Ministry of Health website:http://www.moh.govt.nz/pacific

ForewordHon Tony RyallMinister of HealthHon Georgina te Heuheu QSOMinister of Pacific Island Affairs'Ala Mo'ui sets out the priority outcomes and actions for the next five years that willcontribute towards achieving better health outcomes for Pacific people, families andcommunities.Like other New Zealanders, Pacific people want access to ‘Better, Sooner, More Convenient’health services, and they want accountability for results. The Government is determinedto turn around poor Pacific health outcomes by providing better services closer to home,supporting effective Pacific providers and models of care, and better enabling Pacific peopleand communities to be healthy.Pacific people will be an important focus as the Ministry of Health works towards achievingthe Government’s Health Targets for immunisation, smoking cessation, diabetes andcardiovascular services.Pacific people face particular social and economic issues affecting their health that mustbe addressed. Government initiatives to increase Pacific attendance in early childhoodeducation and achievement at school, and to improve housing insulation and heating willhelp to improve health outcomes.At a time when we have an ageing health workforce and the nationwide shortage of healthprofessionals worsens, the Pacific working age population is growing. This is an importantresource to meet one of the biggest challenges facing the health sector. We need to improveour methods of recruiting, training and retaining Pacific health and disability workers.The Government is committed to addressing these challenges. For example, we will supportthe training of Pacific workers in key areas such as medicine, nursing, oral health and alliedhealth. We will also support initiatives to increase the number of Pacific students takingscience subjects at secondary school to ensure there is a larger pool of tertiary healthstudents in the future.Strong Pacific communities are an integral part of the future prosperity of New Zealand.Leading longer, healthier and more independent lives will enable Pacific people to not onlyenjoy their lives to the fullest, but also be well-educated, skilled and able to play an evengreater part economically, culturally and socially.'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014iii

ContentsForeword............................................................................................................................... iiiIntroduction from the Chief Advisor, Pacific Health................................................................1Purpose.................................................................................................................................. 2Who should use 'Ala Mo'ui.................................................................................................... 2'Ala Mo'ui: Pathways to Pacific Health and Wellbeing......................................................... 2Government goals..............................................................................................................4Principles............................................................................................................................5Priority outcomes and actions...........................................................................................61. Pacific workforce supply meets service demand............................................................72. Systems and services meet the needs of Pacific people................................................93. Every dollar is spent in the best way to improve health outcomes...............................114. More services delivered locally in the community and in primary care....................... 135. Pacific people are better supported to be healthy....................................................... 156. Pacific people experience improved broader determinants of health.......................... 17How will we demonstrate success?......................................................................................19Appendix 1: Development of 'Ala Mo'ui.............................................................................. 20References............................................................................................................................21'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014v

Introduction from the Chief Advisor,Pacific HealthNi sa bula vinaka, Talofa lava, Kia orana, Taloha ni, Malo e lelei, Fakalofa lahi atu, Talofa,Tena koutou and greetings.The name 'Ala Mo'ui is a combination of a number of Pacific languages 1 meaning ‘pathways tothe essence of life force’. It represents the holistic view of health and wellbeing, encompassingthe physical, mental, cultural and spiritual dimensions that are important to Pacific peoples.'Ala Mo'ui – pathways to the essence of life force – is both directional and positive,signifying the way we in the health and disability sector can work to improve Pacific healthover the next five years.Compared with the total New Zealand population, Pacific peoples have poorer health statusacross a wide variety of measures, including child and youth health, risk factors leading topoor health and long-term conditions. From 1981–84 to 2001–04, Pacific amenable mortalityimproved the least of any ethnic group (Tobias and Yeh 2009).The research of Tobias and Yeh suggests that improvements in access to and quality of healthcare for Pacific peoples will make a difference. Keeping this in mind, we also know that Pacificpeoples’ health is shaped by cultural, social and economic factors. Lower incomes, lowereducational attainment and poorer housing contribute significantly to the health status ofPacific people. Strong links to cultural homelands in the Pacific region can influence beliefsabout health and illness, and access and use of health services in New Zealand.All of these factors mean that we need to take a collaborative approach. It means that weneed to be open to new and different strategies that build on the strengths of Pacific familiesand communities. It means we have to be innovative in order to better cater for our youthfulpopulation. It means we need to work with the Ministry of Pacific Island Affairs and othergovernment agencies to address the social and economic factors that influence health.I hope 'Ala Mo'ui assists you in the planning and delivery of ‘Better, Sooner, MoreConvenient’ health care for Pacific communities. This document is the product of collectiveeffort. It is based on wisdom and experience, combined with the most up-to-date Pacifichealth data and research.Thank you to the many individuals, organisations and clinical and community leaders whoprovided input into the development of 'Ala Mo'ui. Many of you serve our Pacific communitiesat the front-line every day, and we look forward to continuing to work with you to improve thehealth of Pacific people.Vinaka vakalevu.Dr Api TalemaitogaChief Advisor, Pacific Health1 Tongan (‘Ala Mo’ui), Niuean (Ala Moui), Samoan (Ala), Cook Island Maori (Ara), Tokelauan (Ala), Tuvaluan (Ala).'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014 1

Purpose'Ala Mo'ui sets out the priority outcomes and actions for the next five years that willcontribute to achieving the Government’s overarching goal that all New Zealanders,including Pacific people, lead longer, healthier and more independent lives.'Ala Mo'ui replaces the Ministry of Health’s Pacific Health and Disability Action Plan(2002), the Pacific Health and Disability Workforce Development Plan (2004) and theJoint Action Plan for the Ministries of Health and Pacific Island Affairs (2008) as the keyoverarching document for improving Pacific health outcomes.'Ala Mo'ui is not a comprehensive list of all activity that contributes to improving the healthof Pacific people. Instead, it sets out the Government’s priority focus areas for Pacific healthin the next five years.Who should use 'Ala Mo'uiAchieving better health outcomes for Pacific peoples requires action by the entire healthand disability sector. The Ministry of Health, District Health Boards (DHBs), primary healthorganisations (PHOs), Pacific and non-Pacific health and disability providers all have arole to play. It also requires action by the Ministry of Pacific Island Affairs, the Ministry ofEducation, Housing New Zealand and other government agencies.'Ala Mo'ui sets out actions that will contribute most to achieving the Government’s goals.It is also a tool for planning and prioritising actions and developing new and innovativemethods of delivering results and value for money.'Ala Mo'ui: Pathways to Pacific Healthand Wellbeing'Ala Mo'ui is made up of three main parts:• What we want: Government goals• What guides us: Principles• Our focus: Priority outcomes and actionsA diagram of 'Ala Mo'ui is provided in Figure 1 over the page, and the different componentsof 'Ala Mo'ui are also described in more detail.2 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014

Figure 1:'Ala Mo'ui:Government goals,priority outcomesand principlesGovernmentgoalsAll New Zealanderslead longer, healthier and moreindependent livesService deliveryis better, soonerand moreconvenientThe health systemis adaptive, innovativeand continuallyimprovingSystems andservices meet theneeds of PacificpeoplePacific workforcesupply meetsservice demand'Ala Mo'ui principlesEvery dollar isspent in the bestway to improvehealth outcomesMore servicesdelivered locally inthe community andin primary care'Ala Mo'uipriorityoutcomes• Respecting Pacifiic culturePacific people arebetter supportedto be healthyPacific peopleexperience improvedbroader determinantsof health• Valuing family• Quality health care• Working together'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014 3

Government goals'Ala Mo'ui contributes to the Government’s strategic direction for ‘Better, Sooner, MoreConvenient’ health care by identifying areas in which the health and disability sector needsto improve performance for Pacific peoples. The Government has three goals for health thatapply to all New Zealanders, and these have a particular meaning in the Pacific context.All New Zealanders lead longer, healthier and more independent lives'Ala Mo'ui contributes to the Government’s overarching goal that all New Zealanders,including Pacific peoples, lead longer, healthier and more independent lives.Leading longer, healthier and more independent lives will enable Pacific peoples to enjoytheir lives to the fullest, take advantage of educational and employment opportunities andparticipate fully in society. Independence is particularly important for Pacific people withdisabilities, who, while valuing their important relationships with family caregivers, alsowant to be able to participate independently in society (Huakau and Bray 2000).While there is much cultural diversity among Pacific communities, there are twocommonly held Pacific beliefs that need to be accommodated in addressing this goal forPacific peoples. The first is that health is a holistic paradigm which includes physical,mental, social and spiritual wellbeing (Pulotu-Endemann et al 2007). This underlinesthe need for Government agencies to work collaboratively in a way that recognises theinterconnectedness of health, education, housing, justice, welfare and employment ascontributors to Pacific wellbeing.The second commonly held belief is that families play a significant role in the health andwellbeing of Pacific peoples collectively and as individuals (Tiatia and Foliaki 2005). Healthyand strong families are the basis for successful Pacific communities in which individuals cangrow and develop to their full potential (Ministry of Pacific Island Affairs 2008). Governmentsupport for Pacific families to be healthy and strong is therefore essential.Service delivery is better, sooner and more convenientBetter service delivery is not only of a high quality, it is also affordable, convenientlylocated, physically accessible and available when it is needed.What works differs between individuals, families and communities. For Pacific people,better service delivery has to be culturally competent. The health and disability system hasnot been meeting the needs of Pacific communities as well as it should. We need to ensurethat services are designed to be better, sooner and more convenient for Pacific people, inparticular by building on what is already working well.The health system is adaptive, innovative and continually improvingTo continue providing quality services in the face of projected constraints on funding,increasing innovation and adaptation will be required across the whole health and disabilitysystem. Innovative and adaptive approaches are particularly important in meeting theneeds of Pacific peoples because of the diversity of Pacific communities and the relativelyrapid changes in their demographic structure. Clinicians, service planners, managers andpolicy makers must not only tailor what they do in a cultural sense; they will also have to beflexible in their response to demographic changes in Pacific communities over time.4 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014

PrinciplesRespecting Pacific cultureIndividuals and organisations in the health and disability system recognise that Pacificpeoples’ experience of health care can be influenced by cultural beliefs and values. Giventhe dynamic nature of the Pacific population in New Zealand, these cultural beliefs andvalues are diverse and evolving. In general, Pacific peoples in New Zealand maintain stronglinks with the Pacific Islands, through family, culture, history and language.Valuing familyWorkers in the health and disability system are aware that, for most Pacific peoples, familyis the centre of the community and way of life. Family provides identity, status, honour,prescribed roles, care and support (Tiatia and Foliaki 2005). Care for family members withdisabilities or for older family members is often informally provided from within the family(Huakau and Bray 2000).Quality health careThe key dimensions of quality – access, equity, cultural competence, safety, effectiveness,efficiency and patient-centeredness – are implicit in the delivery of health and disabilityservices to Pacific peoples (Minister of Health 2003). Quality health care is apparent at theindividual, team, organisation and overall system level.Working togetherThe health and disability system works together to provide seamless quality care. Thehealth and disability sector works together with other sectors (such as education, housingand social development) to ensure that social, environmental, economic and cultural factorsare managed to reduce their negative impacts and increase their positive impacts on Pacificpeoples’ health outcomes.'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014 5

Priority outcomes and actions'Ala Mo'ui seeks to achieve the following six priority outcomes.1. Pacific workforce supply meets service demand.2. Systems and services meet the needs of Pacific people.3. Every dollar is spent in the best way to improve health outcomes.4. More services delivered locally in the community and in primary care.5. Pacific people are better supported to be healthy.6. Pacific people experience improved broader determinants of health.The six priority outcomes of 'Ala Mo'ui are not ranked in order of preference. Instead, theyare interrelated, and together provide a holistic view of Pacific health that recognises theimpact of complex factors at the individual, family, community, health and disability systemand wider societal level.Accompanying each priority outcome are specific actions to be undertaken by the Ministryof Health, DHBs, PHOs, Pacific and non-Pacific health and disability providers, the Ministryof Pacific Island Affairs and other relevant agencies.6 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014

1. Pacific workforce supply meets servicedemandWhy is this outcome a priority?Developing the Pacific health and disability workforce is a priority because ethnic andlinguistic diversity among health professionals is associated with better access to andquality of care for disadvantaged populations (Barwick 2000, United States Department ofHealth and Human Services 2006). Pacific health and disability workers bring connectionswith Pacific communities, personal understanding of Pacific issues, and Pacific cultural andlanguage skills.Currently, there is a significant shortage of New Zealand health and disability workerswith an understanding of Pacific health perspectives and Pacific culture in general (HealthWorkforce Advisory Committee 2006). Pacific peoples make up nearly 7 percent of the totalNew Zealand population, yet in 2007 comprised only 1.6 percent of the medical workforce(Medical Council of New Zealand 2008), and in 2006 2.8 percent of registered nurses and2.7 percent of enrolled nurses. 2 Furthermore, in 2006 Pacific students were less likely to dowell in science subjects at secondary school, a key requirement for entry into many healthworkforce training courses (Health Workforce Advisory Committee 2006).Over the course of their careers, most Pacific health workers care for both Pacific and non-Pacific patients. Pacific health workers have made an important contribution to the careof New Zealanders, particularly as nurses (Zurn and Dumont 2008) and non-regulatedworkers, such as community health workers, health care assistants and caregivers (Samu etal 2009). Developing the Pacific health and disability workforce therefore also contributesto the health and wellbeing of the wider New Zealand public.Increasing the Pacific health and disability workforce will ultimately improve communityhealth literacy. 3 Workforce development (including job creation and skill development) alsohas economic benefits for Pacific individuals, families and communities.What are we seeking to achieve?We want to improve our ability to attract, train and retain Pacific health and disabilityworkers in priority areas where there are shortages, such as primary health care, childhealth, mental health and oral health. We also want to do better at recruiting and retainingqualified Pacific workers for Pacific providers and Pacific-focused services in mainstreamorganisations.The youthful, growing Pacific working age population is and will continue to be animportant resource for the New Zealand health workforce. We want to make best use of thisresource by providing opportunities and support for Pacific people to become health anddisability workers.2 2006 data from the New Zealand Health Information Service.3 Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information andknowledge of services needed to make appropriate health decisions (Ratzan and Parker 2000).'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014 7

What will we do to achieve this?Strengthening the Pacific health and disability workforce will require collaboration acrossthe health and disability sector and other sectors, particularly education.To contribute, the Ministry of Health will:• identify options for upskilling the Pacific non-regulated workforce• work with DHBs, training institutions, service providers and national (professional)Pacific organisations to improve the recruitment, training and ongoing professionaldevelopment of Pacific health workers• use Pacific Provider and Workforce Development funding to:– fund existing initiatives to increase the number of Pacific students taking sciencesubjects– support training of Pacific workers in priority health and disability areas, includingmedicine, nursing, oral health and allied health– support advancing the professional and clinical development of Pacific health anddisability workers.To strengthen the Pacific health and disability workforce, the Ministry of Pacific IslandAffairs will:• focus on raising educational achievement for Pacific youth as a potential pool of futurehealth workers by working with the Ministry of Education on the Pasifika Education Plan.8 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014

2. Systems and services meet the needs ofPacific peopleWhy is this outcome a priority?Like all users of the health care system, Pacific people want services that meet their needsand expectations (Pacific Health Research Centre 2003). Pacific people also want seamlessservice delivery, with effective information flow and patient management between primarycare and other parts of the health system, including hospitals, specialist care, mental healthand disability support services.Research shows that Pacific peoples can experience barriers in access and use of servicesacross the health and disability system (CBG Health Research 2006, Pacific Health ResearchCentre 2003, Ministry of Health et al 2004). These barriers can be financial, cultural,logistical, physical or linguistic (ibid), and are key reasons that Pacific peoples are notbenefiting from health services to the same extent as other groups (Tobias and Yeh 2009).What are we seeking to achieve?Health and disability systems and services need to focus on what works for Pacific peopleand communities. They need to be configured to respond to Pacific people’s needs andexpectations. This is particularly important for health areas of greatest concern, which are:• child and youth health• reducing the prevalence of risk factors affecting health (for example, obesity, alcoholand drug misuse, and smoking)• preventing and managing long-term conditions.Health workers need to be aware that Pacific people have a higher risk of developingcertain conditions, such as rheumatic fever and cardiovascular disease, and to modify theirapproach to assessment and treatment accordingly. For example, Pacific people shouldgenerally undergo cardiovascular risk assessments at a younger age (35 years for malesand 45 years for females) than the general population.Diversity among the Pacific population means that all services (Pacific and non-Pacific) needto be adaptable and innovative. While a community-based or home-based service might bemost effective for an older Pacific person with co-morbidities, a young Pacific person mightprefer a one-stop-shop service.While strengthening the Pacific health and disability workforce and providers is important,we also want to ensure that non-Pacific services effectively meet the needs of Pacificpeople, because most Pacific people receive their health care from non-Pacific providers.Improving cultural competence in service delivery is a key component of this. Culturalcompetence improves health care by making services more acceptable to a wider spectrumof individuals and families, thereby increasing access and use of services by those whoexperience barriers (Tiatia 2008).'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014 9

What will we do to achieve this?To support the development of services that meet the needs of Pacific people, the Ministryof Health will:• encourage DHBs, PHOs and other providers to monitor the health status and patterns ofservice use of Pacific people and respond accordingly• fund innovative approaches and share learnings nationally• work with DHBs to implement actions in Te Kōkiri: The Mental Health and AddictionAction Plan 2006–2015 that will build responsive services for Pacific people who areseverely affected by mental illness or addiction• support Pacific cultural competence initiatives.To assist health and disability workers to effectively meet the needs of Pacific people,regulatory authorities such as the Medical Council of New Zealand will encouragepractitioners to use cultural competence tools in their practice.10 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014

3. Every dollar is spent in the best way toimprove health outcomesWhy is this outcome a priority?Getting the best health value for every dollar spent is more and more critical. Populationageing will place increasing demands on the health and disability system in the future.There will also be increasing expectations of the system to deliver a wider range of servicesand treatments. In parallel, funding increases for health and disability services are likely tobe more constrained than they have been over most of the past decade.What are we seeking to achieve?The Ministry’s Statement of Intent 2009–2012 outlines how the Ministry intends to achievemaximum patient benefit from its resources across the board. We also want healthresources to be used in the best possible way to improve Pacific health outcomes, includingimproving front-line patient services.We know that for many of the health issues of greatest concern, downstream treatment costscan be reduced through effective prevention and protection. For example, breastfeeding andimmunisation both have a protective effect on Pacific child health outcomes. Reducingmodifiable risk factors such as smoking, obesity and high cholesterol can preventcardiovascular conditions, diabetes, stroke, respiratory diseases and some cancers.We also know that effective support and management of long-term conditions withinprimary health care settings can reduce hospital admissions and the use of hospitalemergency departments.We need good monitoring processes to measure the effectiveness of policies andprogrammes, and we need to be able to respond quickly in redirecting resources wheninterventions are not working. We also need better information on the most effectivemethods by which to meet Pacific health needs.What will we do to achieve this?To increase protective factors and reduce risk factors the Ministry of Health will:• continue the national and regional breastfeeding public information and educationprogramme with DHBs• improve the quality of delivery of the Well Child Tamariki Ora programme to Pacificfamilies• undertake research about what influences immunisation choices and behaviours• monitor the effectiveness of Quitline, Pacific-specific smoking cessation services andthe National Pacific Tobacco Control Service• support Pacific self-management of long-term conditions in the context of theirfamily setting.'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014 11

To improve its evidence base, the Ministry of Health will:• undertake analysis of the 2006/07 New Zealand Health Survey on health care utilisationby Pacific people compared with other New Zealanders and by immigration status• develop options to increase Pacific response rates to health surveys• improve the ability to capture within-Pacific diversity in health surveys.The Ministry of Youth Development will identify health and wellbeing issues for Pacificyouth through analysis of data from Youth ’07: the National Survey of the Health andWellbeing of New Zealand Secondary School Students.12 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014

4. More services delivered locally in thecommunity and in primary careWhy is this outcome a priority?Primary health care is one of the most effective ways to promote healthy behaviour, protectagainst diseases through immunisation, and prevent serious illness through screening,early detection and treatment. Primary health care is vital in managing care for Pacificpeople with complex health needs, and is the main channel into secondary care and othertypes of care.Primary health care is often a patient’s first point of contact with health services, and canprovide an access point for other social services, such as financial assistance or housing/accommodation entitlements. This is particularly important for Pacific people withdisabilities or with long-term debilitating conditions. Primary health care is better able toreach and engage Pacific families through community nurses and other community healthworkers. The more Pacific communities are actively involved in the design and delivery ofservices, the more accessible and effective such services will be.Pacific people use both Pacific and non-Pacific primary health care services. Pacific primarycare or community-based providers include general practitioner (GP) services, disabilitysupport services and mental health providers. They play a key role in the delivery ofculturally competent services to Pacific people and families, particularly where there wouldotherwise be cultural or language barriers to care. Pacific providers often facilitate accessto social services for Pacific patients, acknowledging the Pacific notion of holistic healthencompassing spiritual, mental, social and physical wellbeing. Pacific health and disabilityproviders are often very effective at developing innovative and adaptive services to meetPacific health needs.As the majority of Pacific people engage with non-Pacific providers for most of their healthand disability needs, the importance of culturally competent primary health care providerscannot be overstated (Ministry of Health 2008a).What are we seeking to achieve?Pacific people want high quality and culturally competent primary health care servicescloser to home, that are available whatever time of the day they are required (Finau andTukuitonga 2000). Pacific people also want to have effective and long-term relationshipswith their GPs (Pacific Health Research Centre 2003).The Government wants to build on the existing strengths of primary care and communitybasedservices for Pacific peoples by:• encouraging co-located, multidisciplinary family health teams• delivering primary care in a closer relationship with social care• developing a more comprehensive programme for chronic conditions• continuing to deliver affordable services in accessible and convenient settings for Pacificpeople• using appropriate resources and strategies to improve Pacific people’s use of primarycare services• increasing the cultural competence of primary care providers• supporting innovative primary and community-based services for Pacific young people.'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014 13

What will we do to achieve this?The Ministry of Health will work with DHBs, PHOs and other providers to:• establish and develop youth friendly services such as youth one-stop-shops andschool-based health services in low decile secondary schools, teen parent units andalternative education settings• maximise coverage and participation of Pacific women in BreastScreen Aotearoa andthe National Cervical Screening Programme• encourage and support effective Pacific models of service delivery and methods toshare learning• ensure that, as the model of primary care evolves, funding for effective Pacific healthproviders will enable them to benefit from the changes• support Pacific cultural competence of primary care providers.The Ministry of Health will support regional Pacific disability initiatives that provide easieraccess to housing, education, health and welfare support for Pacific people with disabilityand their families.To strengthen the role of Pacific providers, the Ministry of Health will work with Pacificproviders and others in the sector to:• develop intersectoral and interagency networks to support the work of Pacific providers• develop supportive and collaborative partnerships between Pacific and other health anddisability providers• align Pacific provider development with Government service priorities.To strengthen services delivered locally in the community, the Ministry of Pacific IslandAffairs will help to build non-government organisation (NGO) and Pacific provider capacity.14 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014

5. Pacific people are better supported to behealthyWhy is this outcome a priority?Like all New Zealanders, Pacific people desire good health and wellbeing. At the sametime, many Pacific people have beliefs about individual health, and family and communityneeds and realities that are different from those of other New Zealanders (Ministry ofHealth 2008a). These beliefs can influence health choices and behaviours. For instance, thefinancial priorities of many Pacific people centre around maintaining relationships, meetingtheir immediate family needs, donating to church, and making contributions to family, bothin New Zealand and in Pacific countries of origin (Tait 2009). Such financial obligationscan impact on families’ ability to pay for health services. Pacific peoples’ use of traditionalPacific medicine and healing can also influence their use of health care services in NewZealand (Ministry of Health 2008a).Pacific people appear to be more connected socially than many other population groupsin New Zealand (Tait 2009). For example, many Pacific families are strong participants inchurch and community activities, which create and reinforce strong social connections andtherefore resilience (ibid). There have been a number of recent health initiatives which havesuccessfully built on the strengths of Pacific communities, such as the MeNZB campaignfor Pacific children, and Pacific church initiatives to increase physical activity and healthyeating.Because of these unique Pacific factors and strengths, it is important that Pacific peoplehave greater engagement identifying and developing effective approaches that will work forthem. Pacific participation helps to increase wider knowledge and understanding of Pacifichealth issues and encourages collective ownership and action on health issues.While there are complex barriers which impact on the health status of Pacific peoples,health professionals are in a position to better support Pacific peoples to be healthy.For instance, Pacific people are often unaware of the services available to them throughgovernment agencies (Koloto 2007), or from health professionals and providers (PacificHealth Research Centre 2003; Paterson et al 2004). Some groups of Pacific people, oftenthose most in need, face particularly complex barriers in accessing information andsupport. These include Pacific people with disabilities and Pacific informal caregivers(Goodhead and McDonald 2007, Ministry of Health 2008b).International literature shows a link between poor health literacy and poor health outcomes(Lee et al 2004). Ethnic minorities, particularly people who speak English as a secondlanguage, tend to have lower health literacy (Zanchetta and Poureslami 2006).'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014 15

What are we seeking to achieve?We want to enable Pacific people to get the most benefit from the health system, through:• better participation by and representation of Pacific community and clinical leaders atall levels of the health and disability system• support for Pacific community action initiatives which are developed and led by Pacificcommunities• better engagement of Pacific youth (recognising the youthfulness of the Pacificpopulation and the different needs of Pacific youth)• improving the health literacy of Pacific people, to enable them to make healthy choicesand gain better access to the health and disability system.What will we do to achieve this?To increase health literacy, the Ministry of Health will:• develop options to improve Pacific peoples’ access to information on promoting andmaintaining good health• work with the disability support sector to improve access to information on disabilitysupport services.To increase Pacific clinical participation in leadership and planning, the Ministry of Healthwill involve Pacific clinicians in policy and service development.Work that supports Pacific communities to take action to prevent poor health outcomes willcontinue.• The Alcohol Advisory Council of New Zealand (ALAC) will provide funding and trainingfor community initiatives in Pacific communities aimed at preventing alcohol-relatedharm.• The Ministry of Health will continue to work with DHBs to roll-out community actionprojects to increase physical activity and improve nutrition in Pacific communities,providing tangible support for Pacific communities.To ensure that Pacific peoples are better supported to be healthy, the Ministry of PacificIsland Affairs will:• work with the Ministries of Social Development, Health and Education to implementinitiatives to equip Pacific communities with the knowledge and information to reducefamily violence• undertake research on cultural strengths in Pacific communities as a mechanism forsupporting healthy relationships and sexual behaviour.16 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014

6. Pacific people experience improvedbroader determinants of healthWhy is this outcome a priority?There is strong evidence that biological factors, health-related behaviours, access tohealth care and environmental and socioeconomic factors all have an influence on health(Commission on Social Determinants of Health 2008). Environmental and socioeconomicfactors – particularly income, education and employment – have the most significant impacton the health of populations.The determinants of health do not operate independently: there are often complexinteractions between individual risk factors and wider environmental influences inmaintaining health or causing illness. However, many of the determinants of health arealterable to improve health and wellbeing (Ministry of Health 2004).While there have been some improvements, Pacific people are still worse off than otherNew Zealanders across a range of socioeconomic indicators. Improving Pacific peoples’incomes, education, employment and housing is critical to improving their health outcomes.Significant current and emerging health, social and economic issues in the Pacific region(such as non-communicable diseases, and emerging and re-emerging communicablediseases) also have an impact on Pacific peoples in New Zealand.What are we seeking to achieve?Successful interventions for addressing the negative influences of health determinantstend to be those that involve multiple actions across different sectors and at different levels(Commission on Social Determinants of Health 2008). We therefore want to see moreeffective interconnected action to improve health, social and economic outcomes at centralgovernment, regional and local levels.We want greater recognition of the impact of intersectoral activity on Pacific healthoutcomes, and to promote wider use of health impact assessments to assess and developactions to manage health effects of policies and projects.In the wider Pacific region, we want to continue to contribute to initiatives which seek tofoster economic development, eliminate poverty and improve educational outcomes forPacific peoples.What will we do to achieve this?Work to improve the broader determinants of health focuses on increasing participation inearly years education, increasing access to healthy housing and raising living standards.• Housing New Zealand and DHBs will continue implementation of the Healthy Housingproject.'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014 17

• Housing New Zealand will be a lead agency for the implementation of the TamakiTransformation Project – a multi-agency programme that is supported by initiatives toimprove housing, health and service delivery, create jobs, increase safety and improvethe local environment.Work with Pacific Island countries to improve health outcomes for populations in the widerPacific region will continue.• New Zealand’s International Aid and Development Agency and the Ministries of Healthand Foreign Affairs and Trade will support implementation of the Pacific Framework forthe Prevention and Control of Non-Communicable Diseases through the Pacific NCDImplementation Plan (2008–2011).• The Ministry of Health will implement the Arrangement on Health Cooperation andbiennial work programme with the Cook Islands Ministry of Health.To improve Pacific peoples’ broader determinants of health, the Ministry of Pacific IslandAffairs will:• work with the Ministry of Education and across Pacific communities’ networks andpersonnel to promote the importance of early years education• undertake research and explore actions to mobilise collective Pacific wealth to improvePacific peoples’ incomes• explore ways to increase Pacific home ownership and healthy housing through multiborrowerfacilities, partnerships with Pacific churches, the sale of state housing, and thetake-up of government entitlements.18 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014

How will we demonstrate success?The Ministries of Health and Pacific Island Affairs will report to the Ministers of Health andPacific Island Affairs on the implementation of 'Ala Mo'ui every two years, the first reportbeing due by the end of September 2011.Monitoring Pacific health outcomes is essential for identifying patterns and trends,developing appropriate programmes and policies, and driving improvements across thehealth and disability sector.The Ministry of Health will:• monitor progress towards the Health Targets relating to immunisation rates, smokingcessation and services focused on diabetes and cardiovascular disease 4• monitor progress towards the following measures:– increase the proportion of ‘never smokers’ among Pacific Year 10 boys from 56percent in 2008 up to 68 percent in 2012 and Pacific Year 10 girls from 48 percent in2008 up to 60 percent in 2012– increase the proportion of eligible Pacific women who have a breast cancer screenevery two years from 52 percent in 2008 up to 70 percent in 2011.• continue to identify and monitor trends in the health of Pacific peoples• measure whether Pacific peoples have equal access to relevant, quality health services• produce five-yearly key indicator reports that are easily accessible and understood byPacific communities and others in the health sector• ensure full and responsive monitoring of DHB performance.To measure success, the Ministry of Pacific Island Affairs will:• produce the Pacific Report on health and broader results for Pacific peoples• consider selective evaluations on particular issues or organisations periodically• monitor Pacific peoples’ health and broader outcomes and provide policy advice toimprove outcomes.4 DHBs with the largest Pacific populations (Waitemata, Auckland, Counties Manukau, Waikato, Capital and Coast, Hutt Valley, andCanterbury) have agreed Pacific indicators for the Health Targets on immunisation and diabetes /CVD services in their DistrictAnnual Plans 2009/10. These are available at www.moh.govt.nz/healthtargets.'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014 19

Appendix 1: Development of 'Ala Mo'ui'Ala Mo'ui has been developed from focused consultation with clinical and communityhealth leaders, drawing on relevant national and international literature and using the latestavailable Pacific health evidence.'Ala Mo'ui has been informed by the review of the Pacific Health and Disability Action Plan2002 (PHDAP). The PHDAP review consisted of a stocktake of Ministry and DHB activityin areas covered by the PHDAP. It concluded that there is a large amount of activity takingplace to improve Pacific health, but this could be better focused. The PHDAP review alsoresulted in six stand-alone papers:• Improving Quality of Care for Pacific Peoples• Pacific Child Health• Pacific Youth Health• Pacific Peoples and Mental Health• Pacific Peoples’ Experience of Disability• Pacific Cultural Competencies: A literature review.The papers provide detailed analysis of the health status of Pacific people, and collectivelyhighlight priority areas for action. The papers are available at www.moh.govt.nz/pacific.The Ministry of Health would like to acknowledge the assistance of the following peoplewho contributed to the development of 'Ala Mo'ui.The Ministry of Pacific Island Affairs: Dr Colin Tukuitonga, Dr Debbie McLeod, DianeAnorpong, Jon Siakimotu.Clinical experts group: Kim Buchanan, Hilda Fa'asalele, Dr Monique Faleafa, Dr Siro Fuatai,Papali'i Dr Kim Maia'i, Mr Kiki Maoate, Tina McNicholas, Dr Teuila Percival, Fa'amatuainuTino Pereira, Fuimaono Karl Pulotu-Endemann, Dr Debbie Ryan, Debbie Sorenson and SeiuliDr Juliet Walker.The Ministry of Health would also like to thank other clinical and community leaders, andgovernment agencies for their assistance: Lita Foliaki (Waitemata DHB), Manu Sione, AnaeArthur Anae (Counties Manukau DHB), Aseta Redican (Auckland DHB), Siloma Masina(Hutt Valley DHB), Lee Pearce and Taima Fagaloa (Capital and Coast DHB), Hector Mathews(Canterbury DHB), Helen Talamaivao (Midcentral DHB), Helen Wihongi (Northland DHB),Karina Elkington, Leaupepe Peta Karalus (Waikato DHB), Dr PJ Faumui (Whanganui DHB),Christine Briasco and Marion Quinn (NZAID), Gerard Vaughan and Bella Bartley (AlcoholAdvisory Council of New Zealand), Erik Erika (Health Sponsorship Council), Michael Thorn(Medical Council of New Zealand), Jay Farris (Housing New Zealand Corporation), ‘EsetaFinau (Tongan Nurses Association), Anna Bailey, Christina Tapu and Mary Watts (SamoanNurses Association of New Zealand), Malia Hamani (TOA Pacific Inc), Dr Siale 'Alo Foliakiand Philip Beilby (Vaka Tautua), Roine Lealaiauloto (Penina Health Trust), Carmel Peteru.The Ministry of Health also acknowledges the many contributors to the Pacific Health andDisability Action Plan review papers, which have significantly informed 'Ala Mo'ui.20 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014

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Pacific Health Research Centre. 2003. The Pacific Island Primary Health Care UtilisationStudy. Auckland: Pacific Health Research Centre, University of Auckland.Paterson J, Cowley ET, Percival T, et al. 2004. Pregnancy Planning by Mothers of PacificInfants Recently Delivered at Middlemore Hospital. Journal of the New Zealand MedicalAssociation 117: 1188.Pulotu-Endemann FK, Suaali'i-Sauni T, Lui D, et al. 2007. Seitapu Pacific Mental Health andAddiction Cultural and Clinical Competencies Framework. Auckland: The National Centre ofMental Health Research and Workforce Development.Ratzan SC, Parker RM. 2000. Introduction. In: CR Selden, M Zorn, SC Ratzan, et al (eds)National Library of Medicine Current Bibliographies in Medicine: Health literacy. NLM Pub.No. CBM 2000–1. Bethesda, MD: National Institutes of Health, United States Department ofHealth and Human Services.Samu K, Ulugia-Veukiso A, Perese L, et al. 2009. Pacific Non-regulated Health WorkforceStudy Phase 1: Executive summary. Auckland: University of Auckland.Tait R. 2009. An Outcomes Framework for Pacific Peoples in New Zealand. Report for theMinistry of Pacific Island Affairs. URL: http://www.mpia.govt.nz/resources/pdfs/newspublications/Framework%20report%20-%20final.pdfAccessed 29 May 2009.Tiatia J. 2008. Pacific Cultural Competencies: A literature review. Wellington: Ministry ofHealth.Tiatia J, Foliaki L. 2005. Draft 4: Pacific Cultural Competencies Framework for District HealthBoards. Unpublished report.Tobias M, Yeh L. 2009. How Much Does Health Care Contribute to Health Gain and to HealthInequality? Trends in amenable mortality in New Zealand 1981–2004. Australian and NewZealand Journal of Public Health 33 (1): 70–8.United States Department of Health and Human Services. 2006. The Rationale for Diversityin the Health Professions: A review of the evidence. URL: ftp://ftp.hrsa.gov/bhpr/workforce/diversity.pdf Accessed 22 April 2009.Zanchetta MS, Poureslami IM. 2006. Health Literacy within the Reality of Immigrants’Culture and Language. Canadian Journal of Public Health 97 (2): 26–30.Zurn P, Dumont JC. 2008. Health Workforce and International Migration: Can NewZealand compete? OECD Health working paper No.33. URL: http://www.oecd.org/dataoecd/46/41/40673065.pdf Accessed 23 March 2009.22 'Ala Mo'ui: Pathways to Pacific Health and Wellbeing 2010–2014

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